The SPIN Trial (Stories to Promote Information through Narrative) A RCT testing narratives for the dissemination of a national guideline for opioid prescription use in emergency medicine Abstract The SPIN Trial (Stories to Promote Information Using Narrative) is a mixed-methods randomized controlled dissemination trial to test an innovative strategy using written narratives to promote dissemination and utilization of evidence-based guidelines related to opioid prescriptions for emergency physicians. In May 2012, the American College of Emergency Physicians (ACEP) will release evidence-based guidelines to support clinical decisions related to opioid prescriptions for emergency physicians who treat patients with pain. This guideline was developed, in part, due to a national epidemic of unintentional drug overdoses from prescribed opioids. Emergency physicians are one of the highest prescriber groups for this class of medication. Dissemination and implementation of clinical guideline recommendations are notoriously inefficient. The goal of this application is to test two dissemination strategies for the new prescription opioid guideline: narrative and summary. Based on previous investigations, we hypothesize that emergency physicians who are exposed to stories, developed to maximize known characteristics of narrative persuasion, will be more likely to read, recall and intend-to- adopt guideline recommendations compared to those who are exposed to routine summary descriptions alone. This study will have three phases. Phase One will used semi-structured interviews to elicit knowledge gaps, attitudes and beliefs related to opioid prescriptions among emergency physicians. Narratives will then be developed based on these data and known characteristics of narrative persuasion. Phase Two will randomize 30,000 ACEP members to receive a well-read daily e-newsletter containing the narratives or other summary content related to the guideline. Outcomes measured will include use of online hyperlinks to open the guideline and use of an online registration mechanism for enrollment in state sponsored prescription drug monitoring programs (PDMPs), a guideline recommendation. These outcomes reflect dissemination and intention-to-adopt. Phase Three will use qualitative methods to measure post-trial knowledge and intention-to-adopt guideline recommendations, stratified by randomization arm. The SPIN Trial represents an opportunity to test a novel strategy around the dissemination of evidence for an important patient-centered topic.